Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
There are a number of resources available to guide clinicians on these decisions. I recommend the COVID-19 Resources webpage curated by the American Society of Hematology (COI, I'm the editor of that website). https://www.hematology.org/covid-19 This website includes guidance on immunizations in the...
Do you consider an ovarian cancer patient who progresses on PARP inhibitor, either for treatment or maintenance, to be platinum resistant regardless of time since last platinum based chemotherapy?
I would not necessarily. The time since the last platinum is what would drive my answer. It may pan out in fact that the patient is no longer platinum sensitive, but I would not make that determination based on an assumption that progression on PARP = platinum resistance. Although we do say that pla...
How would you manage a recurrent endometrial cancer confined to the vaginal cuff that is completely resected?
At this point, unless there is contraindication to EBRT, we favor the combination of EBRT plus HDR brachy.
How do you manage a cervical cancer that needs interstitial brachytherapy with prolonged thrombocytopenia after concurrent chemoRT?
Although infrequent, we have done pre op plt transfusion to make brachytherapy feasible and to avoid prolonging the total duration.
Do you consider high para-aortic nodes above the renal vessels to be locally advanced or metastatic in cervical cancer?
It sounds like you are asking how aggressively to treat patients with para-aortic nodal spread. My limit for "para-aortic" or "regional LAD" is usually anything below the diaphragm. I generally think of and treat these patients as advanced stage III.I would also advocate for definitively treating ce...
How do you approach staging for a patient with adult granulosa cell tumor, grossly confined to one ovary, and desiring a fertility sparing procedure?
A fertility sparing approach may be considered in this patient as long as a restaging surgical procedure demonstrates no obvious evidence of metastatic disease. The procedure should include a careful inspection of peritoneal surfaces, peritoneal biopsies, and partial omentectomy. Systematic pelvic a...
How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?
Difficult case. Could just observe if the lymph node is an isolated recurrence with no extracapsular extension. If extracapsular extension, could offer standard chemotherapy again, or just single agent carboplatin to minimize side effects x 6 cycles. This patient should have been extra-sensitive to ...
Is there a role for SBRT with vaginal melanoma?
With proximity of rectum, urethra, and vulva, we favor 3DCRT or IMRT to 45-50 Gy at 2.5 Gy per fraction with and without brachy based on response.
Would you treat a vulvar SCC with definitive chemoRT with 50.4 Gy IMRT then boost the GTV with en face with electrons to ~6400?
There is no "one fits all" for vulvar cancer, which is a complex disease with varying disease presentations. The ideal method of boost and the dose depends on the size, location, histology, and other factors. We used to use en face electron boosts much more frequently before we began using IMRT. It ...
Would you alter neoadjuvant chemotherapy regimen for a high grade small cell neuroendocrine carcinoma of the ovary if she has already received cycle 1 of carbo/taxol?
Small cell neuroendocrine tumors of the ovary are rare and of poor prognosis. There are several steps I would take in a situation like the one described in the vignette. Discuss poor prognosis with the patient. Rule out occult primary that is not ovarian. Get early involvement of medical oncologis...